Department of Surgery, University of Verona, Verona, Italy.
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Ann Surg Oncol. 2017 Sep;24(9):2491-2501. doi: 10.1245/s10434-017-5870-y. Epub 2017 May 2.
The influence of morphological status on the long-term outcome of patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC) is poorly defined. We sought to study the impact of morphological status on overall survival (OS) of patients undergoing curative-intent resection for ICC.
A total of 1083 patients who underwent liver resection for ICC between 1990 and 2015 were identified. Data on clinicopathological characteristics, operative details, and morphological status were recorded and analyzed. A propensity score-matched analysis was performed to reduce confounding biases.
Among 1083 patients, 941(86.9%) had a mass-forming (MF) or intraductal-growth (IG) type, while 142 (13.1%) had a periductal-infiltrating (PI) or MF with PI components (MF + PI) ICC. Patients with an MF/IG ICC had a 5-year OS of 41.8% (95% confidence interval [CI] 37.7-45.9) compared with 25.5% (95% CI 17.3-34.4) for patients with a PI/MF + PI (p < 0.001). Morphological type was found to be an independent predictor of OS as patients with a PI/MF + PI ICC had a higher hazard of death (hazard ratio [HR] 1.42, 95% CI 1.11-1.82; p = 0.006) compared with patients who had an MF/IG ICC. Compared with T1a-T1b-T2 MF/IG tumors, T1a-T1b-T2 PI/MF + PI and T3-T4 PI/MF + PI tumors were associated with an increased risk of death (HR 1.47 vs. 3.59). Conversely, patients with T3-T4 MF/IG tumors had a similar risk of death compared with T1a-T1b-T2 MF/IG patients (p = 0.95).
Among patients undergoing curative-intent resection of ICC, morphological status was a predictor of long-term outcome. Patients with PI or MF + PI ICC had an approximately 45% increased risk of death long-term compared with patients who had an MF or IG ICC.
形态学状态对接受肝切除术治疗肝内胆管细胞癌（ICC）患者长期预后的影响尚不清楚。我们旨在研究形态学状态对接受根治性切除的 ICC 患者总生存（OS）的影响。
共纳入 1990 年至 2015 年间接受肝切除术治疗 ICC 的 1083 例患者。记录并分析了临床病理特征、手术细节和形态学状态等数据。采用倾向评分匹配分析来减少混杂偏倚。
在 1083 例患者中，941 例（86.9%）为肿块型（MF）或内胆管生长型（IG），142 例（13.1%）为壁内浸润型（PI）或 MF 伴 PI 成分（MF+PI）ICC。MF/IG ICC 患者的 5 年 OS 为 41.8%（95%置信区间 [CI] 37.7-45.9），而 PI/MF+PI 患者的 5 年 OS 为 25.5%（95% CI 17.3-34.4）（p<0.001）。形态学类型是 OS 的独立预测因素，因为 PI/MF+PI ICC 患者的死亡风险更高（危险比 [HR] 1.42，95% CI 1.11-1.82；p=0.006），而 MF/IG ICC 患者的死亡风险较低。与 T1a-T1b-T2 MF/IG 肿瘤相比，T1a-T1b-T2 PI/MF+PI 和 T3-T4 PI/MF+PI 肿瘤与死亡风险增加相关（HR 1.47 vs. 3.59）。相反，与 T1a-T1b-T2 MF/IG 患者相比，T3-T4 MF/IG 肿瘤患者的死亡风险相似（p=0.95）。
在接受根治性切除 ICC 的患者中，形态学状态是长期预后的预测因素。与 MF/IG ICC 患者相比，PI 或 MF+PI ICC 患者的死亡风险增加约 45%。
